1. Balancing a Healthy Lifestyle A Series of Educational Seminars for Patients presented by the office of Alexander F. Castellanos, M.D., Inc.

2. Tipping the Scales on Vascular Disease April 5, 2005

3. Cholesterol - Good, Bad TriglyceridesHbA1c Kidney Function Liver Function Vascular Function Gender: Men, Women, Mixed? Exercise: Running, Walking, Aikido, Yoga, Pilates Nutrition: Vegetarian, Low Carbs, Fat >160 Factor Stress: Anger, Hostility Weight: Low Weight, Overweight Activity: Exercise, Sedentary Bp Nutrition: Protein, Fat, CHO Diabetes Hormones:EstrogenTestosteroneProgesteroneCortisol Growth Hormone Thyroid - Para Thyroid EpinephrineSerotoninDopamine

4. The 70,000 miles of Arteries that pump blood through your body. Cardiovascular Disease effects the Heart and … Smoking Increasing Age High Blood Pressure Elevated Cholesterol Overweight Diabetes Low Physical Activity Anger/Rage Ethnic Characteristics Family History Risk Factors of Vascular Disease Vascular Disease

5. Arteries open and close in all mammals including men and women Arteries open and close in all mammals including men and women  Damage or Disease of your Circulatory System is called Vascular Disease

6. The Normal Artery  A healthy artery can do its job of pushing blood through out your body. A normal artery is free of plaque formation A normal artery is free of plaque formation The artery wall is very thick and elastic The artery wall is very thick and elastic

7. Plaque Plaque is the accumulation of fats including cholesterol Mild to Moderate plaque formation and damage to the walls of the artery Mild to Moderate plaque formation and damage to the walls of the artery

8. Severe plaque formation and damage to the walls of the arteries can cause Heart Attacks, and Strokes. Plaque

9. Your body is made up of 50 trillion cells. Every second your body produces 25 million new cells. This cell represents any cell of the body a brain cell, skin cell, liver cell etc. (show cell) All cells need to be in close proximity to normal circulation or blood flow so they can continue to function properly. Happy Cells vs. Unhappy Cells “The Happy Cell”

10. “The Unhappy Cell” When food is digested the nutrients are first processed by the liver and are then released into the circulation or blood stream to feed the cells of our bodies. When circulation is blocked or partially blocked the required nutrients can not reach the cell. We call that cell “The Unhappy Cell” Happy Cells vs. Unhappy Cells

11. Unhappy cells in our brain are called: headaches, anxiety, depression, memory loss, altimhierzs or stroke  Unhappy cells in our chest are called: chest pain, palpitations, arrhythmia, congestive heart failure, angina, heart attack  We can do this with any cell in our body and come back with a cause of poor circulation – even with cancer!

12. Angiograms Miss Most Atheromas Conventional angiography fails to visualize 95%- 99% of atherosclerotic plaque, Dr. Steven Nissen said at the annual meeting of the American Association of Clinical Endocrinologists. Conventional angiography fails to visualize 95%- 99% of atherosclerotic plaque, Dr. Steven Nissen said at the annual meeting of the American Association of Clinical Endocrinologists. Massive atheromas lurking within the vascular wall—outside the view of angiography—are the lesions that account for the two-thirds of myocardial infarctions that occur at sites with “hemodynamically insignificant stenosis.” Massive atheromas lurking within the vascular wall—outside the view of angiography—are the lesions that account for the two-thirds of myocardial infarctions that occur at sites with “hemodynamically insignificant stenosis.” Angiogram vs. IVUS of Artery “This is a painful lesson for my colleagues in interventional cardiology. They don't like [to be told] they're looking at the wrong end point” when they give patients with a normal angiogram a clean bill of health, said Dr. Nissen, head of clinical cardiology at the Cleveland Clinic.

13. Factors for Increased Vascular Disease Emotions Emotions Fear Fear Stress/Anxiety Stress/Anxiety Anger Anger Treatments and Medications that Worsen CVD Treatments and Medications that Worsen CVD Poor Nutrition Poor Nutrition Sedentary Lifestyle Sedentary Lifestyle Increased Weight Increased Weight

14. Fat and Vascular Disease New study links fat, inflammation and heart disease - Mar 31 (HeartCenterOnline). Study of the subcutaneous fat in 20 post-menopausal women who had risk factors that raise the risk of heart disease. The study was published in the April issue of the American Journal of Physiology. Main Findings: Fat may directly contribute to inflammation by producing Fat may directly contribute to inflammation by producing inflammatory proteins inflammatory proteins Fat acts like a body organ capable of secreting Fat acts like a body organ capable of secreting hormones and proteins hormones and proteins Fat suppresses anti-inflammatory proteins. Fat suppresses anti-inflammatory proteins. Women with high levels of abdominal fat have higher levels of pro- inflammatory proteins and lower levels of anti- inflammatory proteins Women with high levels of abdominal fat have higher levels of pro- inflammatory proteins and lower levels of anti- inflammatory proteins

15. Hormones and Vascular Disease Women's Health Initiative s "Anti estrogen agenda" The interpretation of the most recent findings of the WHI is a perfect example of this. When the first arm of the WHI study showed a barely significant increase in breast cancer of 8 cases per 10,000 women, this finding was blasted across the media. The interpretation of the most recent findings of the WHI is a perfect example of this. When the first arm of the WHI study showed a barely significant increase in breast cancer of 8 cases per 10,000 women, this finding was blasted across the media. When the second arm showed a decrease in breast cancer of 7 cases per 10,000 women, I did not see one news report, magazine article, or editorial. If any other medication had been shown to decrease breast cancer by 23%, there would have been a national education campaign to get the good news out to the public. When the second arm showed a decrease in breast cancer of 7 cases per 10,000 women, I did not see one news report, magazine article, or editorial. If any other medication had been shown to decrease breast cancer by 23%, there would have been a national education campaign to get the good news out to the public. The statements by Dr. Stephen Hulley and Dr. Deborah Grady in their JAMA editorial (291[14]:1769-71, 2004) verge on being hypocritical. The statements by Dr. Stephen Hulley and Dr. Deborah Grady in their JAMA editorial (291[14]:1769-71, 2004) verge on being hypocritical. Larry Kincheloe, M.D., Oklahoma City

16. Hormones and Vascular Disease Volume 350:482-492 January 29, 2004 Number 5 Risks of Testosterone-Replacement Therapy and Recommendations for Monitoring Ernani Luis Rhoden, M.D., and Abraham Morgentaler, M.D.

17. Waist Size and Diabetes The circumference of a man’s waist is a better predictor of his risk of developing type 2 diabetes than his body mass index (BMI), which is a weight-to-height ratio, or waist-to-hip ratio alone. This finding, published in the March 2005 issue of the American Journal of Clinical Nutrition, is based on data collected from 27,270 men tracked over 13 years who participated in the Harvard Health Professionals Follow- Up Study. American Journal of Clinical NutritionHarvard Health Professionals Follow- Up Study Compared to those in the group with the smallest waists,29-34 inches, the other groups: 34.3-35.9 inches – 2 times more likely to develop diabetes 36-37.8 inches - 3 times more likely to develop diabetes 37.9-39.8 inches - 5 times more likely to develop diabetes 40-62 inches - 12 times more likely to develop diabetes The currently recommended waist circumference cutoff of 40 inches for men may need to be lowered: “Many of the men who developed type 2 diabetes had measurements lower than the cutoff (40 inches for men),” explains Wang, “and the risk associated with waist circumference increased at a much lower level.” http://www.jhsph.edu/PublicHealthNews/Press_Releases/2005/Wang_waistsize.html

18. An Effect of Vascular Disease A Uric Acid Crystal A Gouty Joint Johnson, R. J. et. al. N Engl J Med 2004;350:1071-1073 A Disease of Kings or Those who Eat Like One The Gout, by James Gillray, 1799 Alexander the Great, King Henry VIII, and Poet Laureate Alfred Lord Tennyson all had gout.

19. Low-Fat and Very Low- Fat Weight Loss Diets Anti-CHO < 20% CHO Atkins' Diet Protein Power CHO Addict’s Diet Zone Diet Sugar Busters AHA Weight Watchers Jenny Craig Dash Diet Pritikin Diet Dean Ornish Diet Diet < 30% CHO < 30% Fat  40% CHO 25-35% Fat 55-60% CHO < 15% Fat < 10% Fat Anti-Fat Adapted from: Riley RE. Nutr Aspects of Exercise, 1999. > 30 – 35% protein protein >20% & 20% & < 30%Protein Less than 20% Protein

20. Proliferation of Diet Books Amazon.com search “weight loss” = 1428 matches Amazon.com search “weight loss” = 1428 matches Top 50, best – selling diet books: Top 50, best – selling diet books: 58% were published in 1999 or 2000 58% were published in 1999 or 2000 88% were published since 1997 88% were published since 1997

21. "Studies show that up to 80 percent of coronary heart disease, 90 percent of diabetes and about one third of cancers can be avoided through a change in lifestyle,” Uton Muchtar Rafei, Regional Director of the World Health Organization Balance

22. Control Emotions, Control Stress Control Emotions, Control Stress Exercise – Walk at least 1 hour a day 3-5 days a week Exercise – Walk at least 1 hour a day 3-5 days a week Eat Healthy – reduce fats and animal proteins, largest meals should be lunch and breakfast, watch intake after 5pm. Eat Healthy – reduce fats and animal proteins, largest meals should be lunch and breakfast, watch intake after 5pm. Reduce Weight – “Loose the Fat, Loose the Plaque” Reduce Weight – “Loose the Fat, Loose the Plaque” Waist Managment Waist Managment Quit Smoking Quit Smoking Get Regular Check-ups Get Regular Check-ups Know your Numbers – Cholesterol, Blood Pressure, HGAIC Know your Numbers – Cholesterol, Blood Pressure, HGAIC Balance

23. Cholesterol - Good, Bad TriglyceridesHbA1c Kidney Function Liver Function Vascular Function Gender: Men, Women, Mixed? Exercise: Running, Walking, Aikido, Yoga, Pilates Nutrition: Vegetarian, Low Carbs, Fat >160 Factor Stress: Anger, Hostility Weight: Low Weight, Overweight Activity: Exercise, Sedentary Bp Nutrition: Protein, Fat, CHO Diabetes Hormones:EstrogenTestosteroneProgesteroneCortisol Growth Hormone Thyroid - Para Thyroid EpinephrineSerotoninDopamine

24. Balancing the Research Check Folders for More Information Check Folders for More Information